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SAN 10AQUIN <br /> Environmental Health Department <br /> C O U N T Y---- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 14 Inspector: (iro-'r- t CONSTRUCTION <br /> Facility Address: <br /> Well Address: kid i, w A� Total Depth: <br /> WP# D Well#: Drilling Rig Type: <br /> Soil Boring#: ' ` Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: -..��t,ur <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: iwwh Filter Pack From: To: <br /> Geologist: CI'VLL l v or^Li;k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION CtiRSS'iY-80X <br /> Holding Temperature. COMPLETION <br /> Method: <br /> G=nd Suriacs <br /> Screening Method: p�ovt <br /> Verified Chain of Custody: ❑ Yes El No ft' <br /> SPOILS �.� . <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: �toned <br /> aeon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: I <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: , <br /> Grout Material: 0"' <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 1 oring Destruction Bags of Cement: <br /> METHOD USED l< Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity *remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags izallons Bags <br /> Thicker, Thinnest ueags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 10 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />